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REQUEST FOR STAMPING
(May, 2000)
Contact Name: Head of The Establishment Licence Unit
Tel: (613) 954-6790
Fax: (613) 957-4147
E-Mail: DEL_questions_LEPPP@hc-sc.gc.ca
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(PDF Version - 12 K)(Submit this form with two copies of any material that is to be stamped. One copy of the material will be stamped and returned to you with your Certificates. The other copy will be retained in Health Canada files.)
The undersigned Company requests that Health Canada stamp and return one copy of the enclosed information for attachment to a Certificate of Pharmaceutical Product.
- Product name:
- Summary of attached information and material:
We certify that the attached information and material are accurate and up-to-date and that copies of this information and material are on file with Health Canada.
- Name of Company
- Name of Company Representative
- Title of Company Representative
- Signature of Company Representative
- Date
THIS DOCUMENT MUST BE SWORN BEFORE A NOTARY PUBLIC.
- Name
- Signature (Seal)
- Date
This form is subject to revision. May 2000
